Heart Sounds

Question 1

S1

Answer 1

Mitral and tricuspid valves close

start of systole, heard at apex

Question 2

S2

Answer 2

Pulmonic and aortic valves close

end of systole, heard at base

Question 3

S3

Answer 3

Impaired rapid early filling, follows S2
low pitched diastolic extra sound
ok in youth/athletes
S3 need to pee- volume overload

Question 4

S4

Answer 4

Atrial gallop, precedes S1
late diastolic low pitched extra sound
Always pathological (except in kids)
decreased compliance, pressure overload
(LVH, aortic stenosis, HOCM, dilated CM)

Question 5

Physiological S2 splitting

Answer 5

During inspiration, increased RV filling, longer RV emptying, delayed closure of pulmonic valve
S1 A2 P2

Question 6

Wide fixed splitting of S2

Answer 6

Atrial septal defect

Increased RV filling from VCs and left atria, delayed emptying and P2 closure inspiration and expiration

Question 7

Mitral Regurgitation

Answer 7

Holosystolic

apex

Question 8

Aortic Insuficiency

Answer 8

Diastolic
descresendo
Right 2nd intercostal space

Question 9

Aortic Stenosis

Answer 9

Systolic
Crescendo-Decrescendo
Right 2nd intercostal space, base –> carotids

Question 10

Mitral Stenosis

Answer 10

Diastolic
Opening snap, diastolic rumble
apex with bell

Question 11

Mitral Valve Prolapse

Answer 11

Systolic
midsystolic click, apex
standing- smaller LV, longer louder murmur
squatting- larger LV, shorter mild murmur

Question 12

How does standing or valsalva affect circulation and murmurs?

Answer 12

Decreases venous return/preload

Decrease aortic stenosis
Increase HCM and MVP

Question 13

How does squatting or leg raise affect circulation and murmurs?

Answer 13

Increased blood return to heart, increased preload

Decrease HOCM and MVP
Increase AS

Question 14

How does hand grip affect circulation and murmurs?

Answer 14

Increases after load

Decrease HOCM, AS and MVP